Second Regular Session Seventy-second General Assembly … · 2020-06-13 · Second Regular Session Seventy-second General Assembly STATE OF COLORADO REREVISED This Version Includes

Second Regular SessionSeventy-second General Assembly

STATE OF COLORADOREREVISED

This Version Includes All AmendmentsAdopted in the Second House

LLS NO. 20-1144.02 Christy Chase x2008 SENATE BILL 20-215

Senate Committees House CommitteesFinance FinanceAppropriations Appropriations

A BILL FOR AN ACTCONCERNING MEASURES TO ADDRESS THE AFFORDABILITY OF HEALTH101

INSURANCE FOR COLORADANS PURCHASING COVERAGE ON THE102INDIVIDUAL MARKET, AND, IN CONNECTION THEREWITH,103ESTABLISHING AN ENTERPRISE TO ADMINISTER A HEALTH104INSURANCE AFFORDABILITY FEE ASSESSED ON CERTAIN HEALTH105INSURERS AND A SPECIAL ASSESSMENT ON HOSPITALS TO FUND106MEASURES TO REDUCE CONSUMER COSTS FOR INDIVIDUAL107HEALTH COVERAGE PLANS.108

Bill Summary

(Note: This summary applies to this bill as introduced and doesnot reflect any amendments that may be subsequently adopted. If this billpasses third reading in the house of introduction, a bill summary thatapplies to the reengrossed version of this bill will be available at

HO

USE

Amen

ded

3rd

Rea

ding

June

13,

202

0

HO

USE

Amen

ded

2nd

Rea

ding

June

12,

202

0

SEN

ATE

3rd

Rea

ding

Una

men

ded

June

9, 2

020

SEN

ATE

Amen

ded

2nd

Rea

ding

June

8, 2

020

SENATE SPONSORSHIPMoreno and Donovan, Fenberg, Fields, Gonzales, Rodriguez

HOUSE SPONSORSHIPKennedy and McCluskie, Benavidez, Bird, Buckner, Buentello, Caraveo, Coleman,Cutter, Duran, Esgar, Gonzales-Gutierrez, Gray, Herod, Hooton, Jaquez Lewis, Kipp,Lontine, Melton, Michaelson Jenet, Mullica, Roberts, Snyder, Valdez A., Valdez D.,Weissman, Woodrow

Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.Capital letters or bold & italic numbers indicate new material to be added to existing statute.

Dashes through the words indicate deletions from existing statute.

http://leg.colorado.gov.)

The bill establishes the health insurance affordability enterprise,for purposes of section 20 of article X of the state constitution, that isauthorized to assess a health insurance affordability fee (insurer fee) oncertain health insurers and a special assessment (hospital assessment) onhospitals in order to:

! Provide business services to carriers that pay the fee,including services to increase enrollment in health benefitplans offered by carriers across the state; increasing thenumber of individuals who are able to purchase healthbenefit plans in the individual market by providingfinancial support for certain qualifying individuals; fundingthe reinsurance program that offsets the costs carrierswould otherwise pay for covering consumers with highmedical costs; improving the stability of the marketthroughout the state by providing consistent private healthcare coverage and reducing the movement of individualsbetween group and individual coverage and from insuredto uninsured status; and reducing provider cost shiftingfrom the individual market and the uninsured to the groupmarket; and

! Provide business services to hospitals, including increasinghospital revenues by reducing the amount ofuncompensated care provided by hospitals; and reducingthe need of providers to shift costs of providinguncompensated care to other payers.

The enterprise is to start assessing and collecting the insurer fee in2021, which fee is based on a percentage of premiums collected by healthinsurers in the previous calendar year on health benefit plans issued in thestate. The hospital assessment is a specified amount assessed andcollected in the 2022 and 2023 calendar years. Money collected from theinsurer fee and hospital assessment is to be deposited in the healthinsurance affordability cash fund (fund), which the bill creates. The billalso transfers an amount of premium taxes collected by the state in 2020or later years that exceeds the amount collected in 2019, but not morethan 10% of the enterprise's revenues, to the fund.

The enterprise is required to use the insurer fee, the hospitalassessment, and any premium tax revenues or other money available inthe fund, in accordance with the allocation specified in the bill, for thefollowing purposes:

! To provide funding for the reinsurance program establishedby House Bill 19-1168;

! To provide payments to carriers to increase theaffordability of health insurance on the individual market

215-2-

for Coloradans who receive the premium tax creditavailable under federal law;

! To provide subsidies for state-subsidized individual healthcoverage plans purchased by qualified low-incomeindividuals who are not eligible for the premium tax creditor public assistance health care programs;

! To pay the actual administrative costs of the enterprise andthe division of insurance for implementing andadministering the bill, limited to 3% of the enterprise'srevenues; and

! To pay the costs for consumer enrollment, outreach, andeducation activities regarding health care coverage.

The enterprise is governed by a 9-member board composed of theexecutive director of the Colorado health benefit exchange and thecommissioner of insurance or their designees and 7 members appointedby the governor and representing various aspect of the health careindustry and health care consumers.

With regard to the reinsurance program and enterprise establishedpursuant to House Bill 19-1168, the bill:

! Incorporates the reinsurance program enterprise within thehealth insurance affordability enterprise;

! Eliminates funding for the reinsurance program fromspecial assessments on hospitals and health insurers, excesspremium tax revenues, and specified transfers from thestate general fund and instead allocates a portion of thehealth insurance affordability enterprise revenues to thereinsurance program annually; and

! Extends the reinsurance program, subject to federalapproval of a new or extended state innovation waiver toenable the state to operate the reinsurance program andaccess federal funding for the program.

Be it enacted by the General Assembly of the State of Colorado:1

SECTION 1. In Colorado Revised Statutes, add part 12 to article2

16 of title 10 as follows:3

PART 124

HEALTH INSURANCE AFFORDABILITY ACT5

10-16-1201. Short title. THE SHORT TITLE OF THIS PART 12 IS THE6

"HEALTH INSURANCE AFFORDABILITY ACT".7

215-3-

10-16-1202. Legislative declaration. (1) THE GENERAL1

ASSEMBLY FINDS AND DECLARES THAT:2

(a) THE STATE, CARRIERS, AND HOSPITALS SHARE A COMMON3

COMMITMENT TO ENSURING ALL COLORADANS HAVE ACCESS TO4

AFFORDABLE HEALTH CARE COVERAGE BECAUSE ACCESS TO COVERAGE5

IMPROVES HEALTH OUTCOMES AND PROVIDES FINANCIAL SECURITY FOR6

COLORADANS;7

(b) HOSPITALS WITHIN THE STATE INCUR THE COSTS OF8

UNCOMPENSATED CARE TO UNINSURED AND UNDERINSURED POPULATIONS;9

(c) THE ECONOMIC DOWNTURN DUE TO COVID-19 AND ITS10

IMPACTS ON GROUP AND INDIVIDUAL HEALTH CARE COVERAGE IN THE11

STATE CREATES ECONOMIC CHALLENGES FOR CARRIERS FROM THE12

POTENTIAL LOST REVENUE IF PEOPLE DROP INSURANCE COVERAGE;13

(d) THIS PART 12 IS ENACTED TO PROVIDE THE FOLLOWING14

SERVICES AND BENEFITS TO CARRIERS:15

(I) REDUCING THE NUMBER OF COLORADANS WHO LACK HEALTH16

CARE COVERAGE BY HELPING COLORADANS TO MAINTAIN CONSISTENT17

COVERAGE;18

(II) PROVIDING STABILITY IN THE INSURANCE MARKET;19

(III) REDUCING THE MOVEMENT OF INDIVIDUALS BETWEEN20

INSURED AND UNINSURED STATUS;21

(IV) OFFSETTING THE COSTS CARRIERS WOULD OTHERWISE PAY22

FOR COVERED PERSONS' HIGH MEDICAL COSTS SO THAT PREMIUMS ARE SET23

AT MORE AFFORDABLE LEVELS; AND24

(V) CREATING A HEALTHIER RISK POOL FOR ALL CARRIERS BY25

ESTABLISHING A PATH FOR CONSISTENT COVERAGE FOR INDIVIDUALS; AND26

(e) THIS PART 12 IS ENACTED TO PROVIDE THE FOLLOWING27

215-4-

SERVICES AND BENEFITS TO HOSPITALS:1

(I) REDUCING THE AMOUNT OF UNCOMPENSATED CARE PROVIDED2

BY HOSPITALS; 3

(II) REDUCING THE NEED OF PROVIDERS TO SHIFT COSTS OF4

PROVIDING UNCOMPENSATED CARE TO OTHER PAYERS; AND5

(III) EXPANDING ACCESS TO HIGH-QUALITY, AFFORDABLE HEALTH6

CARE FOR LOW-INCOME AND UNINSURED COLORADANS.7

(2) THE GENERAL ASSEMBLY FURTHER FINDS AND DECLARES THAT,8

CONSISTENT WITH THE DETERMINATION OF THE COLORADO SUPREME9

COURT IN NICHOLL V. E-470 PUBLIC HIGHWAY AUTHORITY, 896 P.2d 85910

(COLO. 1995), THE POWER TO IMPOSE TAXES IS INCONSISTENT WITH11

ENTERPRISE STATUS UNDER SECTION 20 OF ARTICLE X OF THE STATE12

CONSTITUTION, AND THE HEALTH INSURANCE AFFORDABILITY FEES AND13

SPECIAL ASSESSMENTS CHARGED AND COLLECTED BY THE HEALTH14

INSURANCE AFFORDABILITY ENTERPRISE ARE FEES, NOT TAXES, BECAUSE15

THE FEES AND ASSESSMENTS ARE IMPOSED FOR THE SPECIFIC PURPOSE OF16

ALLOWING THE ENTERPRISE TO DEFRAY THE COSTS OF PROVIDING THE17

BUSINESS SERVICES SPECIFIED IN SECTION 10-16-1204 (1)(a) TO THE18

CARRIERS AND HOSPITALS THAT PAY THE FEES AND ASSESSMENTS AND ARE19

COLLECTED AT RATES THAT ARE REASONABLY CALCULATED BASED ON THE20

BENEFITS RECEIVED BY THOSE CARRIERS AND HOSPITALS.21

10-16-1203. Definitions. AS USED IN THIS PART 12, UNLESS THE22

CONTEXT OTHERWISE REQUIRES:23

(1) "BOARD" MEANS THE HEALTH INSURANCE AFFORDABILITY24

BOARD CREATED IN SECTION 10-16-1207.25

(2) "CHILDREN'S BASIC HEALTH PLAN" HAS THE MEANING SET26

FORTH IN SECTION 25.5-8-103 (2).27

215-5-

(3) "ENTERPRISE" MEANS THE COLORADO HEALTH INSURANCE1

AFFORDABILITY ENTERPRISE CREATED IN SECTION 10-16-1204.2

(4) "FEDERAL POVERTY LINE" HAS THE SAME MEANING AS3

"POVERTY LINE", AS DEFINED IN 42 U.S.C. SEC. 9902 (2).4

(5) "FEE" MEANS THE HEALTH INSURANCE AFFORDABILITY FEE5

ESTABLISHED AND ASSESSED PURSUANT TO SECTION 10-16-1205.6

(6) "FUND" MEANS THE HEALTH INSURANCE AFFORDABILITY CASH7

FUND CREATED IN SECTION 10-16-1206.8

(7) "HOUSEHOLD INCOME" HAS THE SAME MEANING AS SET FORTH9

IN 26 U.S.C. SEC. 36B (d)(2) OF THE FEDERAL "INTERNAL REVENUE CODE10

OF 1986", AS AMENDED.11

(8) "MEDICAID" MEANS FEDERAL INSURANCE OR ASSISTANCE AS12

PROVIDED BY TITLE XIX OF THE FEDERAL "SOCIAL SECURITY ACT", AS13

AMENDED, AND THE "COLORADO MEDICAL ASSISTANCE ACT", ARTICLES14

4, 5, AND 6 OF TITLE 25.5.15

(9) "MEDICARE" MEANS FEDERAL INSURANCE OR ASSISTANCE16

PROVIDED BY THE "HEALTH INSURANCE FOR THE AGED ACT", TITLE XVIII17

OF THE FEDERAL "SOCIAL SECURITY ACT", AS AMENDED, 42 U.S.C. SEC.18

1395 ET SEQ.19

(10) "PREMIUM TAX CREDIT" MEANS THE REFUNDABLE TAX CREDIT20

AVAILABLE PURSUANT TO THE FEDERAL ACT TO ASSIST CERTAIN21

INDIVIDUALS IN PURCHASING A HEALTH BENEFIT PLAN ON THE EXCHANGE.22

(11) "PUBLIC BENEFIT CORPORATION" MEANS A PUBLIC BENEFIT23

CORPORATION FORMED PURSUANT TO PART 5 OF ARTICLE 101 OF TITLE 724

THAT IS ORGANIZED AND OPERATED BY THE EXCHANGE PURSUANT TO25

SECTION 10-22-106 (3) FOR THE PURPOSE OF ADMINISTERING AND26

OPERATING A SUBSIDY TO REDUCE THE COSTS OF HEALTH CARE COVERAGE27

215-6-

OFFERED UNDER A STATE-SUBSIDIZED INDIVIDUAL HEALTH COVERAGE1

PLAN.2

(12) "QUALIFIED INDIVIDUAL" MEANS AN INDIVIDUAL,3

REGARDLESS OF IMMIGRATION STATUS, WHO:4

(a) IS A COLORADO RESIDENT;5

(b) HAS A HOUSEHOLD INCOME OF NOT MORE THAN THREE6

HUNDRED PERCENT OF THE FEDERAL POVERTY LINE; AND7

(c) IS NOT ELIGIBLE FOR THE PREMIUM TAX CREDIT, MEDICAID,8

MEDICARE, OR THE CHILDREN'S BASIC HEALTH PLAN.9

(13) "REINSURANCE PROGRAM" MEANS THE COLORADO10

REINSURANCE PROGRAM CREATED IN PART 11 OF THIS ARTICLE 16.11

(14) "REINSURANCE PROGRAM CASH FUND" MEANS THE12

REINSURANCE PROGRAM CASH FUND CREATED IN SECTION 10-16-1107.13

(15) "STATE-SUBSIDIZED INDIVIDUAL HEALTH COVERAGE PLAN"14

MEANS A SUBSIDIZED INDIVIDUAL HEALTH COVERAGE PLAN OFFERED BY15

CARRIERS TO QUALIFIED INDIVIDUALS THROUGH THE PUBLIC BENEFIT16

CORPORATION.17

10-16-1204. Health insurance affordability enterprise -18

creation - powers and duties - assess and allocate health insurance19

affordability fee and special assessment. (1) (a) THERE IS HEREBY20

CREATED IN THE DIVISION THE COLORADO HEALTH INSURANCE21

AFFORDABILITY ENTERPRISE. THE ENTERPRISE IS AND OPERATES AS A22

GOVERNMENT-OWNED BUSINESS WITHIN THE DIVISION FOR THE PURPOSE23

OF ASSESSING AND COLLECTING THE HEALTH INSURANCE AFFORDABILITY24

FEE FROM CARRIERS THAT OFFER HEALTH BENEFIT PLANS IN THE STATE25

AND A SPECIAL ASSESSMENT ON HOSPITALS IN THE STATE AND USING AND26

ALLOCATING THE FEE AND ASSESSMENT FOR THE PURPOSES SPECIFIED IN27

215-7-

THIS PART 12 IN ORDER TO:1

(I) PROVIDE THE FOLLOWING BUSINESS SERVICES TO CARRIERS2

THAT PAY THE FEE:3

(A) OUTREACH AND RELATED WORK TO INCREASE ENROLLMENT4

IN HEALTH BENEFIT PLANS OFFERED BY CARRIERS ACROSS THE STATE;5

(B) INCREASING THE NUMBER OF INDIVIDUALS WHO PURCHASE6

HEALTH BENEFIT PLANS IN THE INDIVIDUAL MARKET BY PROVIDING7

FINANCIAL SUPPORT TO INDIVIDUALS TO PURCHASE PRIVATE HEALTH8

INSURANCE COVERAGE;9

(C) FUNDING THE REINSURANCE PROGRAM THAT OFFSETS THE10

COSTS CARRIERS WOULD OTHERWISE PAY FOR COVERING CONSUMERS WITH11

HIGH MEDICAL COSTS;12

(D) IMPROVING THE STABILITY OF THE MARKET THROUGHOUT THE13

STATE BY PROVIDING CONSISTENT PRIVATE HEALTH CARE COVERAGE AND14

REDUCING THE MOVEMENT OF INDIVIDUALS FROM INSURED TO15

UNINSURED STATUS; AND16

(E) REDUCING PROVIDER COST SHIFTING FROM THE INDIVIDUAL17

MARKET AND THE UNINSURED TO THE GROUP MARKET; 18

(F) CREATING A HEALTHIER RISK POOL FOR ALL CARRIERS BY19

ESTABLISHING A PATH FOR CONSISTENT COVERAGE FOR INDIVIDUALS; AND20

(II) PROVIDE THE FOLLOWING BUSINESS SERVICES TO HOSPITALS:21

(A) REDUCING THE AMOUNT OF UNCOMPENSATED CARE PROVIDED22

BY HOSPITALS; 23

(B) REDUCING THE NEED OF PROVIDERS TO SHIFT COSTS OF24

PROVIDING UNCOMPENSATED CARE TO OTHER PAYERS; AND25

(C) EXPANDING ACCESS TO HIGH-QUALITY, AFFORDABLE HEALTH26

CARE FOR LOW-INCOME AND UNINSURED COLORADANS.27

215-8-

(b) (I) THE ENTERPRISE CONSTITUTES AN ENTERPRISE FOR1

PURPOSES OF SECTION 20 OF ARTICLE X OF THE STATE CONSTITUTION SO2

LONG AS IT RETAINS THE AUTHORITY TO ISSUE REVENUE BONDS AND3

RECEIVES LESS THAN TEN PERCENT OF ITS TOTAL REVENUES IN GRANTS, AS4

DEFINED IN SECTION 24-77-102 (7), FROM ALL COLORADO STATE AND5

LOCAL GOVERNMENTS COMBINED. SO LONG AS IT CONSTITUTES AN6

ENTERPRISE PURSUANT TO THIS SECTION, THE ENTERPRISE IS NOT A7

DISTRICT FOR PURPOSES OF SECTION 20 OF ARTICLE X OF THE STATE8

CONSTITUTION.9

(II) THE ENTERPRISE IS HEREBY AUTHORIZED TO ISSUE REVENUE10

BONDS FOR THE EXPENSES OF THE ENTERPRISE, SECURED BY REVENUES OF11

THE ENTERPRISE.12

(2) THE ENTERPRISE'S PRIMARY POWERS AND DUTIES ARE:13

(a) TO ASSESS AND COLLECT THE FEE SPECIFIED IN SECTION14

10-16-1205 (1)(a)(I);15

(b) TO ASSESS AND COLLECT THE SPECIAL ASSESSMENT ON16

HOSPITALS SPECIFIED IN SECTION 10-16-1205 (1)(a)(II);17

(c) TO ALLOCATE MONEY IN THE FUND IN ACCORDANCE WITH18

SECTION 10-16-1205 (2);19

(d) TO ISSUE REVENUE BONDS PAYABLE FROM THE REVENUES OF20

THE ENTERPRISE;21

(e) (I) TO ENGAGE THE SERVICES OF THIRD PARTIES SERVING AS22

CONTRACTORS AND CONSULTANTS, INCLUDING THE DIVISION, FOR23

PROFESSIONAL AND TECHNICAL ASSISTANCE AND ADVICE AND TO SUPPLY24

OTHER SERVICES RELATED TO THE CONDUCT OF THE AFFAIRS OF THE25

ENTERPRISE, WITHOUT REGARD TO THE "PROCUREMENT CODE", ARTICLES26

101 TO 112 OF TITLE 24. THE ENTERPRISE SHALL ENCOURAGE DIVERSITY27

215-9-

IN APPLICATIONS FOR CONTRACTS AND SHALL GENERALLY AVOID USING1

SINGLE-SOURCE BIDS.2

(II) THE DIVISION SHALL PROVIDE OFFICE SPACE AND3

ADMINISTRATIVE STAFF TO THE ENTERPRISE PURSUANT TO A CONTRACT4

ENTERED INTO UNDER THIS SUBSECTION (2)(e).5

(f) TO ENGAGE IN OUTREACH AND RELATED EFFORTS TO INCREASE6

ENROLLMENT IN HEALTH BENEFIT PLANS ACROSS THE STATE; AND7

(g) TO ADOPT AND AMEND OR REPEAL POLICIES FOR THE8

REGULATION OF ITS AFFAIRS AND THE CONDUCT OF ITS BUSINESS9

CONSISTENT WITH THIS PART 12.10

(3) THE ENTERPRISE SHALL EXERCISE ITS POWERS AND PERFORM11

ITS DUTIES AS IF THE SAME WERE TRANSFERRED TO THE DIVISION BY A12

TYPE 2 TRANSFER, AS DEFINED IN SECTION 24-1-105.13

10-16-1205. Health insurance affordability fee - special14

assessment on hospitals - allocation of revenues. (1) (a) (I) STARTING15

IN THE 2021 CALENDAR YEAR, THE ENTERPRISE SHALL ASSESS AND16

COLLECT FROM CARRIERS, BY JULY 15 EACH YEAR, A HEALTH INSURANCE17

AFFORDABILITY FEE. THE FEE AMOUNT IS BASED ON THE FOLLOWING18

PERCENTAGES OF PREMIUMS COLLECTED BY THE FOLLOWING CARRIERS IN19

THE IMMEDIATELY PRECEDING CALENDAR YEAR ON HEALTH BENEFIT20

PLANS ISSUED IN THE STATE:21

(A) ONE AND FIFTEEN HUNDREDTHS PERCENT OF PREMIUMS22

COLLECTED BY NONPROFIT CARRIERS; AND23

(B) TWO AND ONE-TENTH PERCENT OF PREMIUMS COLLECTED BY24

FOR-PROFIT CARRIERS.25

(II) FOR THE 2022 AND 2023 CALENDAR YEARS, THE ENTERPRISE26

SHALL ASSESS AND COLLECT FROM HOSPITALS A SPECIAL ASSESSMENT OF27

215-10-

TWENTY MILLION DOLLARS PER YEAR, SUBJECT TO SUBSECTION (5) OF THIS1

SECTION. THE ENTERPRISE SHALL NOT COLLECT THE SPECIAL ASSESSMENT2

FOR THE 2022 CALENDAR YEAR BEFORE OCTOBER 1, 2022.3

(b) THE ENTERPRISE SHALL USE THE FEE, THE SPECIAL ASSESSMENT4

ON HOSPITALS, AND ANY OTHER MONEY AVAILABLE IN THE FUND AS5

FOLLOWS, ALLOCATED IN ACCORDANCE WITH SUBSECTION (2) OF THIS6

SECTION:7

(I) TO PROVIDE FUNDING FOR THE REINSURANCE PROGRAM;8

(II) TO PROVIDE PAYMENTS TO CARRIERS TO INCREASE THE9

AFFORDABILITY OF HEALTH INSURANCE ON THE INDIVIDUAL MARKET FOR10

COLORADANS WHO RECEIVE THE PREMIUM TAX CREDIT;11

(III) TO PROVIDE SUBSIDIES FOR STATE-SUBSIDIZED INDIVIDUAL12

HEALTH COVERAGE PLANS PURCHASED BY QUALIFIED INDIVIDUALS;13

(IV) TO PAY THE ACTUAL ADMINISTRATIVE COSTS OF THE14

ENTERPRISE FOR IMPLEMENTING AND ADMINISTERING THIS PART 12,15

LIMITED TO THREE PERCENT OF THE ENTERPRISE'S REVENUES. ACTUAL16

ADMINISTRATIVE COSTS INCLUDE THE FOLLOWING:17

(A) THE ADMINISTRATIVE COSTS OF THE ENTERPRISE, INCLUDING18

THE COSTS TO IMPLEMENT AND ADMINISTER THE PROGRAMS ESTABLISHED19

PURSUANT TO THIS PART 12;20

(B) THE ENTERPRISE'S ACTUAL COSTS RELATED TO21

IMPLEMENTING AND MAINTAINING THE FEE AND SPECIAL ASSESSMENT ON22

HOSPITALS, INCLUDING PERSONAL SERVICES AND OPERATING EXPENSES;23

AND24

(C) THE COSTS FOR CONDUCTING ANALYSES NECESSARY TO25

DETERMINE THE PAYMENTS TO BE MADE TO CARRIERS FOR THE PURPOSES26

DESCRIBED IN SUBSECTION (1)(b)(II) OF THIS SECTION AND THE27

215-11-

REQUIREMENTS FOR STATE-SUBSIDIZED INDIVIDUAL HEALTH COVERAGE1

PLANS OFFERED BY CARRIERS; AND2

(V) TO PAY THE COSTS FOR CONSUMER ENROLLMENT, OUTREACH,3

AND EDUCATION ACTIVITIES REGARDING HEALTH CARE COVERAGE,4

INCLUDING:5

(A) INCREASING GRANTS TO THE EXCHANGE'S CERTIFIED6

ASSISTANCE NETWORK;7

(B) MARKETING FOR THE EXCHANGE;8

(C) GRANTS TO COMMUNITY-BASED ORGANIZATIONS THAT ARE9

ABLE TO ASSIST WITH OUTREACH AND ENROLLMENT, PARTICULARLY IN10

COMMUNITIES THAT FACE THE GREATEST BARRIERS TO ENROLLING IN11

HEALTH CARE COVERAGE; AND12

(D) IMPROVING THE CONNECTION BETWEEN UNEMPLOYMENT13

SERVICES AND ENROLLMENT IN HEALTH CARE COVERAGE.14

(c) THIS SUBSECTION (1) DOES NOT APPLY TO PLANS OR BENEFITS15

PROVIDED UNDER MEDICAID, MEDICARE, OR THE CHILDREN'S BASIC16

HEALTH PLAN.17

(2) (a) THE ENTERPRISE SHALL TRANSMIT THE FEES AND SPECIAL18

ASSESSMENTS COLLECTED PURSUANT TO THIS SECTION TO THE STATE19

TREASURER FOR DEPOSIT IN THE HEALTH INSURANCE AFFORDABILITY CASH20

FUND CREATED IN SECTION 10-16-1206 AND, EXCEPT AS PROVIDED IN21

SUBSECTION (4) OF THIS SECTION, SHALL ALLOCATE THE MONEY IN THE22

FUND IN ACCORDANCE WITH THIS SUBSECTION (2).23

(b) THE ENTERPRISE SHALL ALLOCATE THE REVENUES COLLECTED24

IN 2021, AND ANY OTHER MONEY DEPOSITED IN THE FUND IN 2021, AS25

FOLLOWS:26

(I) UP TO THREE PERCENT FOR ACTUAL ADMINISTRATIVE COSTS AS27

215-12-

SET FORTH IN SUBSECTION (1)(b)(IV) OF THIS SECTION;1

(II) TO THE REINSURANCE PROGRAM CASH FUND, AN AMOUNT2

NECESSARY TO FUND THE PAYMENT PARAMETERS OF THE REINSURANCE3

PROGRAM, AS DETERMINED PURSUANT TO SECTION 10-16-1105 (2), NOT TO4

EXCEED NINETY MILLION DOLLARS OR, IF THE REVENUES COLLECTED5

PURSUANT TO SUBSECTION (1)(a) OF THIS SECTION ARE LESS THAN NINETY6

MILLION DOLLARS, THE AMOUNT COLLECTED; AND7

(III) OF ANY REMAINING BALANCE IN THE FUND AFTER DEDUCTING8

THE ALLOCATIONS SPECIFIED IN SUBSECTIONS (2)(b)(I) AND (2)(b)(II) OF9

THIS SECTION:10

(A) UP TO ONE PERCENT OF THE TOTAL AMOUNT OF REVENUES11

COLLECTED OR DEPOSITED INTO THE FUND IN 2021, BUT NOT MORE THAN12

ONE MILLION FIVE HUNDRED THOUSAND DOLLARS, FOR IMPLEMENTATION13

COSTS AND CONSUMER ENROLLMENT, OUTREACH, AND EDUCATION14

ACTIVITIES REGARDING HEALTH CARE COVERAGE AS DESCRIBED IN15

SUBSECTION (1)(b)(V) OF THIS SECTION; AND16

(B) THE REMAINING BALANCE TO CARRIERS TO REDUCE THE COSTS17

OF INDIVIDUAL HEALTH PLANS FOR INDIVIDUALS WHO PURCHASE AN18

INDIVIDUAL HEALTH BENEFIT PLAN ON THE EXCHANGE AND RECEIVE THE19

PREMIUM TAX CREDIT.20

21

(c) THE ENTERPRISE SHALL ALLOCATE THE REVENUES COLLECTED22

IN 2022, AND ANY OTHER MONEY DEPOSITED IN THE FUND IN 2022, AS23

FOLLOWS:24

(I) UP TO THREE PERCENT FOR ACTUAL ADMINISTRATIVE COSTS AS25

SET FORTH IN SUBSECTION (1)(b)(IV) OF THIS SECTION;26

(II) TO THE REINSURANCE PROGRAM CASH FUND, EIGHTY-EIGHT27

215-13-

MILLION DOLLARS; AND1

(III) OF THE REMAINING BALANCE IN THE FUND AFTER DEDUCTING2

THE ALLOCATIONS SPECIFIED IN SUBSECTIONS (2)(c)(I) AND (2)(c)(II) OF3

THIS SECTION:4

(A) THIRTY PERCENT TO CARRIERS TO REDUCE THE COSTS OF5

INDIVIDUAL HEALTH PLANS FOR INDIVIDUALS WHO PURCHASE AN6

INDIVIDUAL HEALTH BENEFIT PLAN ON THE EXCHANGE AND RECEIVE THE7

PREMIUM TAX CREDIT; AND8

(B) SEVENTY PERCENT FOR SUBSIDIES FOR STATE-SUBSIDIZED9

INDIVIDUAL HEALTH COVERAGE PLANS PURCHASED BY QUALIFIED10

INDIVIDUALS.11

(d) (I) THE ENTERPRISE SHALL ALLOCATE THE REVENUES12

COLLECTED IN 2023 AND EACH YEAR THEREAFTER, AND ANY OTHER13

MONEY DEPOSITED IN THE FUND IN 2023 AND EACH YEAR THEREAFTER, IN14

THE FOLLOWING AMOUNTS AND ORDER OF PRIORITY:15

(A) FIRST, UP TO THREE PERCENT FOR ACTUAL ADMINISTRATIVE16

COSTS AS SET FORTH IN SUBSECTION (1)(b)(IV) OF THIS SECTION;17

(B) SECOND, EIGHTEEN MILLION DOLLARS FOR SUBSIDIES FOR18

STATE-SUBSIDIZED INDIVIDUAL HEALTH COVERAGE PLANS PURCHASED BY19

QUALIFIED INDIVIDUALS;20

(C) THIRD, THE AMOUNT REMAINING IN THE FUND, UP TO21

SEVENTY-THREE PERCENT OF THE TOTAL AMOUNT OF REVENUES22

COLLECTED OR DEPOSITED INTO THE FUND IN THE APPLICABLE YEAR, BUT23

NOT TO EXCEED NINETY MILLION DOLLARS, TO THE REINSURANCE24

PROGRAM CASH FUND; AND25

(D) FOURTH, TEN PERCENT OF THE TOTAL AMOUNT OF26

REVENUES COLLECTED OR DEPOSITED INTO THE FUND IN THE APPLICABLE27

215-14-

YEAR OR THE AMOUNT REMAINING IN THE FUND, WHICHEVER IS LESS, TO1

CARRIERS TO REDUCE THE COSTS OF INDIVIDUAL HEALTH PLANS FOR2

INDIVIDUALS WHO PURCHASE AN INDIVIDUAL HEALTH BENEFIT PLAN ON3

THE EXCHANGE AND RECEIVE THE PREMIUM TAX CREDIT.4

(II) IF, AFTER MAKING THE ALLOCATIONS SPECIFIED IN SUBSECTION5

(2)(d)(I) OF THIS SECTION, THERE IS MONEY REMAINING IN THE FUND IN6

THE APPLICABLE YEAR, THE ENTERPRISE SHALL ALLOCATE THE REMAINING7

MONEY FOR SUBSIDIES FOR STATE-SUBSIDIZED INDIVIDUAL HEALTH8

COVERAGE PLANS PURCHASED BY QUALIFIED INDIVIDUALS.9

(3) THE ENTERPRISE SHALL DISTRIBUTE THE ALLOCATIONS10

SPECIFIED IN SUBSECTION (2) OF THIS SECTION IN ACCORDANCE WITH THE11

REQUIREMENTS DETERMINED BY THE BOARD PURSUANT TO SECTION12

10-16-1207 (4).13

(4) IF THE COMMISSIONER, PURSUANT TO SECTION 10-16-1107 (4),14

NOTIFIES THE BOARD THAT THE REINSURANCE PROGRAM WILL RECEIVE15

FEDERAL FUNDING PURSUANT TO A FEDERAL REINSURANCE PROGRAM OR16

OTHER FEDERAL FINANCIAL ASSISTANCE FOR THE REINSURANCE PROGRAM17

THAT IS IN EXCESS OF FEDERAL PASS-THROUGH FUNDING RECEIVED18

PURSUANT TO SECTION 10-16-1107 (1)(a)(I), THE ENTERPRISE MAY19

ELIMINATE OR REDUCE THE AMOUNT OF ENTERPRISE REVENUES20

ALLOCATED TO THE REINSURANCE PROGRAM PURSUANT TO SUBSECTION21

(2) OF THIS SECTION BASED ON THE AMOUNT OF FEDERAL FUNDING THE22

REINSURANCE PROGRAM RECEIVES, AS INDICATED IN THE COMMISSIONER'S23

NOTICE, AND SHALL REALLOCATE THE PORTION OF THE ENTERPRISE24

REVENUES NO LONGER ALLOCATED TO THE REINSURANCE PROGRAM TO25

THE OTHER PURPOSES SPECIFIED IN SUBSECTION (2) OF THIS SECTION IN26

ACCORDANCE WITH THAT SUBSECTION (2).27

215-15-

(5) (a) THE SPECIAL ASSESSMENTS ON HOSPITALS UNDER1

SUBSECTION (1)(a)(II) OF THIS SECTION MUST COMPLY WITH AND NOT2

VIOLATE 42 CFR 433.68. IF THE FEDERAL CENTERS FOR MEDICARE AND3

MEDICAID SERVICES IN THE UNITED STATES DEPARTMENT OF HEALTH AND4

HUMAN SERVICES INFORMS THE STATE THAT THE STATE WILL NOT BE IN5

COMPLIANCE WITH 42 CFR 433.68 AS A RESULT OF THE SPECIAL6

ASSESSMENT ON HOSPITALS PURSUANT TO SUBSECTION (1)(a)(II) OF THIS7

SECTION, THE ENTERPRISE SHALL REDUCE THE AMOUNT OF THE SPECIAL8

ASSESSMENT AS NECESSARY TO AVOID ANY REDUCTION IN THE9

HEALTHCARE AFFORDABILITY AND SUSTAINABILITY FEE COLLECTED10

PURSUANT TO SECTION 25.5-4-402.4.11

(b) A HOSPITAL SHALL PAY THE SPECIAL ASSESSMENT IMPOSED12

PURSUANT TO SUBSECTION (1)(a)(II) OF THIS SECTION FROM ITS GENERAL13

REVENUES AND IS PROHIBITED FROM:14

(I) COLLECTING AN ASSESSMENT FROM CONSUMERS AS ANY TYPE15

OF SURCHARGE ON ITS FEES;16

(II) PASSING THE SPECIAL ASSESSMENT ON TO CONSUMERS AS ANY17

TYPE OF INCREASE TO FEES OR CHARGES FOR SERVICES; OR18

(III) OTHERWISE PASSING THE SPECIAL ASSESSMENT ON TO19

CONSUMERS IN ANY MANNER.20

10-16-1206. Health insurance affordability cash fund -21

creation. (1) THERE IS HEREBY CREATED IN THE STATE TREASURY THE22

HEALTH INSURANCE AFFORDABILITY CASH FUND. THE FUND CONSISTS OF:23

(a) THE FEES COLLECTED FROM CARRIERS PURSUANT TO SECTION24

10-16-1205 (1)(a)(I);25

(b) THE SPECIAL ASSESSMENTS COLLECTED FROM HOSPITALS26

PURSUANT TO SECTION 10-16-1205 (1)(a)(II);27

215-16-

(c) AN AMOUNT OF PREMIUM TAX REVENUES DEPOSITED IN THE1

FUND PURSUANT TO SECTION 10-3-209 (4)(a)(III), NOT TO EXCEED, IN ANY2

YEAR, TEN PERCENT OF THE TOTAL AMOUNT THE ENTERPRISE COLLECTS3

FROM CARRIERS AND HOSPITALS UNDER SECTION 10-16-1205 (1)(a); 4

(d) THE REVENUE COLLECTED FROM REVENUE BONDS ISSUED5

PURSUANT TO SECTION 10-16-1204 (1)(b)(II); AND6

(e) ALL INTEREST AND INCOME DERIVED FROM THE DEPOSIT AND7

INVESTMENT OF MONEY IN THE FUND.8

(2) MONEY IN THE FUND SHALL NOT BE TRANSFERRED TO ANY9

OTHER FUND, EXCEPT AS PROVIDED IN SECTION 10-16-1205 (2), AND SHALL10

NOT BE USED FOR ANY PURPOSE OTHER THAN THE PURPOSES SPECIFIED IN11

THIS PART 12.12

(3) ALL MONEY IN THE FUND IS CONTINUOUSLY AVAILABLE AND13

APPROPRIATED TO THE ENTERPRISE TO USE IN ACCORDANCE WITH THIS14

PART 12.15

(4) THE FUND IS PART OF THE ENTERPRISE ESTABLISHED PURSUANT16

TO SECTION 10-16-1204 (1).17

10-16-1207. Health insurance affordability board - creation -18

membership - powers and duties - subject to open meetings and19

public records laws - commissioner rules. (1) (a) THERE IS HEREBY20

CREATED THE HEALTH INSURANCE AFFORDABILITY BOARD, WHICH BOARD21

IS RESPONSIBLE FOR GOVERNANCE OF THE ENTERPRISE ESTABLISHED IN22

THIS PART 12. THE BOARD CONSISTS OF THE FOLLOWING ELEVEN VOTING23

MEMBERS:24

(I) THE EXECUTIVE DIRECTOR OF THE EXCHANGE OR THE25

EXECUTIVE DIRECTOR'S DESIGNEE;26

(II) THE COMMISSIONER OR THE COMMISSIONER'S DESIGNEE; AND27

215-17-

(III) NINE MEMBERS APPOINTED BY THE GOVERNOR, WITH THE1

CONSENT OF THE SENATE, AS FOLLOWS:2

(A) ONE MEMBER WHO IS EMPLOYED BY A CARRIER;3

(B) ONE MEMBER WHO IS A REPRESENTATIVE OF A STATEWIDE4

ASSOCIATION OF HEALTH BENEFIT PLANS;5

(C) ONE MEMBER REPRESENTING PRIMARY CARE HEALTH CARE6

PROVIDERS WHO DOES NOT REPRESENT A CARRIER;7

(D) THREE MEMBERS WHO ARE CONSUMERS OF HEALTH CARE WHO8

ARE NOT REPRESENTATIVES OR EMPLOYEES OF A HOSPITAL, CARRIER, OR9

OTHER HEALTH CARE INDUSTRY ENTITY. TO THE EXTENT POSSIBLE, THE10

GOVERNOR SHALL ENSURE THAT THE CONSUMER MEMBERS OF THE BOARD11

ARE INDIVIDUALS WHO LACK AFFORDABLE OFFERS OF COVERAGE FROM12

THEIR EMPLOYERS AND OTHERWISE STRUGGLE TO AFFORD TO PURCHASE13

HEALTH INSURANCE.14

(E) ONE MEMBER WHO REPRESENTS A HEALTH CARE ADVOCACY15

ORGANIZATION; 16

(F) ONE MEMBER WHO IS A REPRESENTATIVE OF A BUSINESS THAT17

PURCHASES OR OTHERWISE PROVIDES HEALTH INSURANCE FOR ITS18

EMPLOYEES; AND19

(G) ONE MEMBER WHO REPRESENTS A RURAL, CRITICAL ACCESS,20

OR INDEPENDENT HOSPITAL.21

22

(b) TO THE EXTENT POSSIBLE, THE GOVERNOR SHALL ATTEMPT TO23

APPOINT BOARD MEMBERS WHO REFLECT THE DIVERSITY OF THE STATE24

WITH REGARD TO RACE, ETHNICITY, IMMIGRATION STATUS, INCOME,25

WEALTH, ABILITY, AND GEOGRAPHY. IN CONSIDERING GEOGRAPHIC26

DIVERSITY, THE GOVERNOR SHALL ENSURE AT LEAST ONE MEMBER27

215-18-

RESIDES ON THE EASTERN PLAINS AND ONE MEMBER RESIDES ON THE1

WESTERN SLOPE AND, TO THE EXTENT POSSIBLE, SHALL ATTEMPT TO2

APPOINT MEMBERS FROM EACH CONGRESSIONAL DISTRICT IN THE STATE.3

(c) THE GOVERNOR SHALL MAKE INITIAL APPOINTMENTS TO THE4

BOARD BY OCTOBER 1, 2020.5

(2) (a) (I) EXCEPT AS PROVIDED IN SUBSECTION (2)(a)(II) OF THIS6

SECTION, THE TERM OF OFFICE OF THE MEMBERS OF THE BOARD APPOINTED7

BY THE GOVERNOR IS FOUR YEARS, AND THOSE MEMBERS MAY SERVE NO8

MORE THAN TWO FOUR-YEAR TERMS.9

(II) IN ORDER TO ENSURE STAGGERED TERMS OF OFFICE, THE10

INITIAL TERM OF OFFICE OF THE MEMBERS OF THE BOARD IS:11

(A) TWO YEARS FOR THE MEMBERS APPOINTED PURSUANT TO12

SUBSECTIONS (1)(a)(III)(A), (1)(a)(III)(C), AND (1)(a)(III)(F) OF THIS13

SECTION AND FOR TWO OF THE MEMBERS APPOINTED PURSUANT TO14

SUBSECTION (1)(a)(III)(D) OF THIS SECTION; AND15

(B) FOUR YEARS FOR THE MEMBERS APPOINTED PURSUANT TO16

SUBSECTIONS (1)(a)(III)(B), (1)(a)(III)(E), AND (1)(a)(III)(G) OF THIS17

SECTION AND FOR ONE OF THE MEMBERS APPOINTED PURSUANT TO18

SUBSECTION (1)(a)(III)(D) OF THIS SECTION.19

(b) MEMBERS OF THE BOARD APPOINTED BY THE GOVERNOR SERVE20

AT THE PLEASURE OF THE GOVERNOR AND MAY BE REMOVED BY THE21

GOVERNOR.22

(c) A MEMBER WHO IS APPOINTED TO FILL A VACANCY SHALL23

SERVE THE REMAINDER OF THE UNEXPIRED TERM OF THE MEMBER WHOSE24

VACANCY IS BEING FILLED.25

(d) MEMBERS OF THE BOARD MAY BE REIMBURSED FOR ACTUAL26

AND NECESSARY EXPENSES, INCLUDING ANY REQUIRED DEPENDENT CARE27

215-19-

AND DEPENDENT OR ATTENDANT TRAVEL, FOOD, AND LODGING, WHILE1

ENGAGED IN THE PERFORMANCE OF OFFICIAL DUTIES OF THE BOARD.2

(3) THE BOARD SHALL MEET AS OFTEN AS NECESSARY TO CARRY3

OUT ITS DUTIES PURSUANT TO THIS PART 12.4

(4) THE BOARD IS AUTHORIZED TO:5

(a) IMPLEMENT AND ADMINISTER THE ENTERPRISE;6

(b) ESTABLISH ADMINISTRATIVE AND ACCOUNTING PROCEDURES7

FOR THE OPERATION OF THE ENTERPRISE;8

(c) RECOMMEND, FOR APPROVAL AND ESTABLISHMENT BY THE9

COMMISSIONER BY RULE:10

(I) THE TIMING AND METHODOLOGY FOR ASSESSING AND11

COLLECTING THE FEE AND SPECIAL ASSESSMENT, SUBJECT TO SECTION12

10-16-1205 (1)(a);13

(II) THE DISTRIBUTION OF ENTERPRISE REVENUES ALLOCATED FOR14

CARRIER PAYMENTS AND SUBSIDIES IN A MANNER THAT IMPROVES15

AFFORDABILITY FOR SUBSIDIZED POPULATIONS AND INDIVIDUALS NOT16

ELIGIBLE FOR THE PREMIUM TAX CREDIT, MEDICAID, MEDICARE, OR THE17

CHILDREN'S BASIC HEALTH PLAN;18

(III) THE PAYMENTS AUTHORIZED BY THIS PART 12 TO BE MADE TO19

CARRIERS TO REDUCE THE COSTS OF INDIVIDUAL HEALTH PLANS FOR20

INDIVIDUALS WHO PURCHASE AN INDIVIDUAL HEALTH BENEFIT PLAN ON21

THE EXCHANGE AND RECEIVE THE PREMIUM TAX CREDIT; AND22

(IV) THE PARAMETERS FOR IMPLEMENTING THE SUBSIDIES FOR23

STATE-SUBSIDIZED INDIVIDUAL HEALTH COVERAGE PLANS AUTHORIZED BY24

THIS PART 12, INCLUDING:25

(A) THE COVERAGE REQUIRED UNDER STATE-SUBSIDIZED26

INDIVIDUAL HEALTH COVERAGE PLANS, WHICH COVERAGE MUST MAXIMIZE27

215-20-

AFFORDABILITY FOR QUALIFIED INDIVIDUALS AND MUST INCLUDE1

COVERAGE FOR THE LOWEST INCOME GROUP, AS DETERMINED BY THE2

BOARD, THAT HAS NO PREMIUM AND PROVIDES BENEFITS ACTUARIALLY3

EQUIVALENT TO NINETY PERCENT OF THE FULL ACTUARIAL VALUE OF THE4

BENEFITS PROVIDED UNDER THE PLAN; AND5

(B) THE CRITERIA AND PROCEDURES FOR DETERMINING WHETHER6

AN INDIVIDUAL IS A QUALIFIED INDIVIDUAL ELIGIBLE TO ENROLL IN A7

STATE-SUBSIDIZED INDIVIDUAL HEALTH COVERAGE PLAN; AND8

(d) ESTABLISH BYLAWS, AS APPROPRIATE AND CONSISTENT WITH9

THIS PART 12, FOR ITS EFFECTIVE OPERATION.10

(5) THE COMMISSIONER SHALL ADOPT RULES NECESSARY FOR THE11

ADMINISTRATION AND IMPLEMENTATION OF THIS PART 12. IN ADOPTING12

THE RULES, THE COMMISSIONER SHALL CONSIDER THE RECOMMENDATIONS13

OF THE BOARD AND SHALL EXPRESS IN WRITING THE REASONS FOR ANY14

DEVIATION FROM THE BOARD RECOMMENDATIONS.15

(6) MEETINGS OF THE BOARD ARE SUBJECT TO THE OPEN MEETINGS16

PROVISIONS OF THE "COLORADO SUNSHINE ACT OF 1972", CONTAINED IN17

PART 4 OF ARTICLE 6 OF TITLE 24. EXCEPT AS OTHERWISE PROVIDED IN THE18

"COLORADO OPEN RECORDS ACT", PART 2 OF ARTICLE 72 OF TITLE 24, OR19

OTHER APPLICABLE STATE OR FEDERAL LAW, RECORDS OF THE BOARD AND20

THE PROGRAM ARE SUBJECT TO THE "COLORADO OPEN RECORDS ACT".21

10-16-1208. Limitation on authority - public option. NOTHING22

IN THIS PART 12 AUTHORIZES THE ENTERPRISE, THE BOARD, OR THE23

COMMISSIONER TO ESTABLISH, ADMINISTER, OPERATE, OR REQUIRE24

PARTICIPATION BY CARRIERS OR HOSPITALS IN A STATE OR PUBLIC OPTION25

HEALTH COVERAGE PLAN.26

SECTION 2. In Colorado Revised Statutes, 10-16-107, add (8)27

215-21-

as follows:1

10-16-107. Rate filing regulation - benefits ratio - rules.2

(8) (a) THE COMMISSIONER MAY ADOPT RULES DESIGNED TO:3

(I) MAXIMIZE THE PURCHASING POWER OF EXCHANGE CONSUMERS4

WHOSE HOUSEHOLD INCOME IS UP TO FOUR HUNDRED PERCENT OF THE5

FEDERAL POVERTY LINE; AND6

(II) ASSURE PREMIUM PRICING THAT COMPLIES WITH THE7

REQUIREMENTS IN THE FEDERAL ACT FOR MODIFIED COMMUNITY RATING.8

(b) IN ADOPTING THESE RULES, THE COMMISSIONER MAY CONSIDER9

THE RESULTS OF THE EVALUATION AND STUDY OF THE REINSURANCE10

PROGRAM CONDUCTED PURSUANT TO SECTION 10-16-1104 (2).11

SECTION 3. In Colorado Revised Statutes, 10-16-1104, amend12

(1)(g); and repeal (1)(f) as follows:13

10-16-1104. Commissioner powers and duties - rules - study14

and report. (1) The commissioner has all powers necessary to15

implement this part 11 and is specifically authorized to:16

(f) Assess special fees against hospitals and, if applicable, carriers17

for the continuous operation of the reinsurance program, as provided in18

section 10-16-1108;19

(g) IN ACCORDANCE WITH SECTION 10-16-1109, apply for a state20

innovation waiver OR AN EXTENSION OF A STATE INNOVATION WAIVER;21

APPLY FOR federal funds; or APPLY FOR both in accordance with section22

10-16-1109, A WAIVER OR EXTENSION OF A WAIVER AND FEDERAL FUNDS23

for the implementation and operation of the reinsurance program;24


(1)(a), (1)(b), (1)(c), (1)(e)(I), and (2)(b) introductory portion; and add26

(2)(a.5) as follows:27

215-22-

10-16-1105. Reinsurance program - creation - enterprise1

status - subject to waiver or funding approval - operation - payment2

parameters - calculation of reinsurance payments - eligible carrier3

requests - definition. (1) (a) There is hereby created in the division the4

Colorado reinsurance program to provide reinsurance payments to5

eligible carriers. Implementation and operation of the reinsurance6

program is contingent upon approval of the A state innovation waiver, AN7

EXTENSION OF A STATE INNOVATION WAIVER, or A federal funding request8

submitted by the commissioner in accordance with section 10-16-1109.9

(b) (I) The reinsurance program constitutes an enterprise for10

purposes of section 20 of article X of the state constitution as long as the11

commissioner, on behalf of the program, retains authority to issue12

revenue bonds and the program receives less than ten percent of its total13

revenues in grants, as defined in section 24-77-102 (7), from all Colorado14

state and local governments combined. So long as it constitutes an15

enterprise pursuant to this section, the program is not a district for16

purposes of section 20 of article X of the state constitution IS PART OF THE17

COLORADO HEALTH INSURANCE AFFORDABILITY ENTERPRISE ESTABLISHED18

PURSUANT TO PART 12 OF THIS ARTICLE 16.19

(II) Subject to approval by the general assembly, either by bill or20

joint resolution, and after approval by the governor pursuant to section 3921

of article V of the state constitution, the commissioner, on behalf of the22

reinsurance program, is hereby authorized to issue revenue bonds for the23

expenses of the program, secured by revenues of the program.24

(c) If the A state innovation waiver, AN EXTENSION OF A STATE25

INNOVATION WAIVER, or A federal funding request submitted by the26

commissioner pursuant to section 10-16-1109 is approved, the27

215-23-

commissioner shall implement and operate the reinsurance program in1

accordance with this section.2

(e) (I) On a quarterly basis during the applicable benefit year,3

(A) each eligible carrier shall report to the commissioner its4

claims costs that exceed the attachment point for that benefit year.5

(B) Each hospital that is subject to the special fees assessed6

pursuant to section 10-16-1108 shall report to the commissioner the7

amount the hospital is responsible for funding in the benefit year; and8

(C) If special fees are assessed against carriers pursuant to section9

10-16-1108 (1)(b), each carrier that is subject to the special fees shall10

report to the commissioner on its collected assessments in that benefit11

year.12

(2) (a.5) TO THE GREATEST EXTENT POSSIBLE, THE COMMISSIONER13

SHALL SET THE PAYMENT PARAMETERS FOR THE 2021 BENEFIT YEAR AT14

AMOUNTS TO MAINTAIN THE TARGETED CLAIMS REDUCTIONS ACHIEVED IN15

THE 2020 BENEFIT YEAR.16

(b) For the 2021 2022 benefit year AND EACH BENEFIT YEAR17

THEREAFTER, after a stakeholder process, the commissioner shall establish18

and publish the payment parameters for that benefit year by March 1519

2020 OF THE IMMEDIATELY PRECEDING CALENDAR YEAR. In setting the20

payment parameters under this subsection (2)(b), the commissioner shall21

consider the following factors as they apply in each geographic rating22

area in the state:23


(4) as follows:25

10-16-1106. Accounting - reports - audits. (4) On or before26

November 1, 2020, and on or before November 1 2021 OF EACH YEAR27

215-24-

THEREAFTER, the division shall include an update regarding the program1

in its report to the members of the applicable committees of reference in2

the senate and house of representatives as required by the "State3

Measurement for Accountable, Responsive, and Transparent (SMART)4

Government Act", part 2 of article 7 of title 2.5


(1); and add (4) as follows:7

10-16-1107. Funding for reinsurance program - sources -8

permitted uses - reinsurance program cash fund - calculation of total9

funding for program. (1) (a) There is hereby created in the state10

treasury the reinsurance program cash fund REFERRED TO IN THIS SECTION11

AS THE "FUND", which consists of:12

(I) Federal pass-through funding granted pursuant to 42 U.S.C.13

sec. 18052 (a)(3) or any other federal funds that are made available for14

the reinsurance program;15

(II) Special fees assessed against hospitals and, if applicable,16

carriers as provided in section 10-16-1108;17

(III) The following amounts transferred from the general fund to18

the reinsurance program cash fund, but only if House Bill 19-1245 is19

enacted at the first regular session of the seventy-second general assembly20

and becomes law:21

(A) Fifteen million dollars, transferred to the fund on June 30,22

2020; and23

(B) Forty million dollars, transferred to the fund on June 30, 2021;24

(IV) An amount of premium tax revenues deposited in the fund25

pursuant to section 10-3-209 (4)(a)(III); and26

(V) (II) Any money the general assembly appropriates to the fund27

215-25-

for the program; AND1

(III) ANY AMOUNTS ALLOCATED TO THE FUND PURSUANT TO2

SECTION 10-16-1205 (2).3

(b) All money deposited or paid into or TRANSFERRED,4

ALLOCATED, OR appropriated to the reinsurance program cash fund,5

including interest or income earned on the investment of money in the6

fund, is continuously available and appropriated to the division to be7

expended in accordance with this part 11. Any interest or income earned8

on the investment of money in the fund shall be credited to the fund.9

(c) The reinsurance program cash fund is part of the reinsurance10

program enterprise established pursuant to section 10-16-1105 (1)(b)11

COLORADO HEALTH INSURANCE AFFORDABILITY ENTERPRISE ESTABLISHED12

PURSUANT TO PART 12 OF THIS ARTICLE 16.13

(4) (a) IF, AFTER THE EFFECTIVE DATE OF THIS SUBSECTION (4), THE14

UNITED STATES CONGRESS ENACTS AND THE PRESIDENT SIGNS FEDERAL15

LEGISLATION ESTABLISHING OR THE SECRETARY OF THE UNITED STATES16

DEPARTMENT OF HEALTH AND HUMAN SERVICES IMPLEMENTS A FEDERAL17

REINSURANCE PROGRAM THAT PROVIDES FEDERAL FUNDING FOR THE18

REINSURANCE PROGRAM OR OTHERWISE MAKES ADDITIONAL FEDERAL19

FUNDS AVAILABLE FOR THE REINSURANCE PROGRAM IN EXCESS OF THE20

AMOUNT RECEIVED AS FEDERAL PASS-THROUGH FUNDING PURSUANT TO21

SUBSECTION (1)(a)(I) OF THIS SECTION, THE COMMISSIONER SHALL NOTIFY22

THE HEALTH INSURANCE AFFORDABILITY BOARD CREATED IN SECTION23

10-16-1207 OF THE AMOUNT OF FEDERAL FUNDING IN EXCESS OF THE24

FEDERAL PASS-THROUGH FUNDING THAT WILL BE AVAILABLE FOR THE25

REINSURANCE PROGRAM AND THE DATE THE FUNDING IS EXPECTED TO BE26

RECEIVED.27

215-26-

(b) IF THE REINSURANCE PROGRAM RECEIVES FEDERAL FUNDING1

AS DESCRIBED IN THIS SUBSECTION (4) TO MAKE REINSURANCE PAYMENTS2

TO CARRIERS IN A GIVEN YEAR AFTER THE HEALTH INSURANCE3

AFFORDABILITY ENTERPRISE HAS ALLOCATED MONEY TO THE4

REINSURANCE PROGRAM PURSUANT TO SECTION 10-16-1205 (2) FOR THAT5

YEAR, THE COMMISSIONER SHALL RETURN TO THE ENTERPRISE THE6

ALLOCATION OR A PORTION OF THE ALLOCATION, AS DETERMINED BY THE7

ENTERPRISE, BASED ON THE AMOUNT OF FEDERAL FUNDING RECEIVED FOR8

THAT YEAR.9

SECTION 7. In Colorado Revised Statutes, repeal 10-16-1108.10


(1)(a) as follows:12

10-16-1109. State innovation waiver - federal funding -13

Colorado reinsurance program. (1) (a) For purposes of implementing14

and operating the reinsurance program as set forth in this part 11 for plan15

years starting on or after January 1, 2020 2021, the commissioner may16

apply to the secretary of the United States department of health and17

human services for:18

(I) A two-year state innovation waiver In accordance with section19

1332 of the federal act, codified at 42 U.S.C. sec. 18052, and 45 CFR20

155.1300:21

(A) ONE OR MORE EXTENSIONS OF THE INITIAL TWO-YEAR STATE22

INNOVATION WAIVER RECEIVED BEFORE THE EFFECTIVE DATE OF THIS23

SUBSECTION (1)(a)(I), AS AMENDED, OF UP TO FIVE YEARS PER EXTENSION;24

OR25

(B) A NEW STATE INNOVATION WAIVER OF UP TO FIVE YEARS TO26

FOLLOW THE INITIAL TWO-YEAR STATE INNOVATION WAIVER APPROVED27

215-27-

BEFORE THE EFFECTIVE DATE OF THIS SUBSECTION (1)(a)(I), AS AMENDED,1

AND SUBSEQUENT EXTENSIONS OF ANY NEW STATE INNOVATION WAIVER2

APPROVED BY THE SECRETARY;3

(II) Federal funds for the reinsurance program; or4

(III) A NEW OR EXTENDED state innovation waiver and federal5

funds.6

SECTION 9. In Colorado Revised Statutes, 10-16-1110, repeal7

(2) as follows:8

10-16-1110. Repeal of part - notice to revisor of statutes.9

(2) This part 11 is repealed, effective September 1, 2023.10


(4)(a)(III) as follows:12

10-3-209. Tax on premiums collected - exemptions - penalties.13

(4) (a) The division of insurance shall transmit all taxes, penalties, and14

fines it collects under this section to the state treasurer for deposit in the15

general fund; except that the state treasurer shall deposit amounts in the16

specified cash funds as follows:17

(III) (A) For the 2020-21 STATE FISCAL YEAR and 2021-22 EACH18

state fiscal years YEAR THEREAFTER, in the reinsurance program HEALTH19

INSURANCE AFFORDABILITY cash fund created in section 10-16-110720

SECTION 10-16-1206, an amount equal to the amount of premium taxes21

collected pursuant to this section in the 2020 calendar year OR ANY22

SUBSEQUENT CALENDAR YEAR that exceeds the amount of premium taxes23

collected pursuant to this section in the 2019 calendar year, SUBJECT TO24

SUBSECTION (4)(a)(III)(B) OF THIS SECTION.25

(B) This subsection (4)(a)(III) is repealed, effective September 1,26

2023 THE AMOUNT OF PREMIUM TAXES DEPOSITED IN THE HEALTH27

215-28-

INSURANCE AFFORDABILITY CASH FUND PURSUANT TO THIS SUBSECTION1

(4)(a)(III) IN ANY GIVEN YEAR SHALL NOT EXCEED TEN PERCENT OF THE2

AMOUNT OF REVENUES COLLECTED BY THE HEALTH INSURANCE3

AFFORDABILITY ENTERPRISE PURSUANT TO SECTION 10-16-1205 IN THAT4

YEAR. THE HEALTH INSURANCE AFFORDABILITY BOARD ESTABLISHED IN5

SECTION 10-16-1207 SHALL NOTIFY THE TREASURER OF THE MAXIMUM6

AMOUNT OF PREMIUM TAXES THAT MAY BE DEPOSITED IN THE HEALTH7

INSURANCE AFFORDABILITY CASH FUND TO COMPLY WITH THIS8

SUBSECTION (4)(a)(III)(B).9

SECTION 11. Safety clause. The general assembly hereby finds,10

determines, and declares that this act is necessary for the immediate11

preservation of the public peace, health, or safety.12

215-29-

Second Regular Session Seventy-second General Assembly … · 2020-06-13 · Second Regular Session Seventy-second General Assembly STATE OF COLORADO REREVISED This Version Includes

Documents